Current trends in splinting the hand in children with neurological impairments

Abstract

AIM: The study aimed to explore Occupational therapy clinicians' current splinting practises in hand function intervention for children with neurological impairments within the South African context. METHODOLOGY: A quantitative cross-sectional design with use of an electronic questionnaire served to address the objectives of this study. The sample included occupational therapists working within the paediatric neurology field in South Africa. The study sample was accessed via convenience and snowball sampling in order to target therapists specifically working in the area of paediatric neurology. RESULTS AND DISCUSSION: Forty therapists from around South Africa (majority from KwaZulu Natal) completed the survey in its entirety. Therapists splint for various reasons and splints are considered effective in neurological cases. The three most prevalent splints were the functional resting, thumb abductor and anti-spasticity splint with the purpose of splinting mainly reported to maintain or improve range of motion (ROM). In this study, therapists appeared to consider knowledge, competency and experience prior to the availability of resources when rationalising the choice to splint. CONCLUSIONS: This study provides insight into the splinting practices amongst occupational therapists who work with neurologically impaired children. Despite the controversy that surrounds splinting in neurology, therapists are using splints in their management with a number of factors considered during the decision-making process. Key words: Splinting, paediatrics, neurology, occupational therapy

Bridging the Gap between Clinical Service and Academic Education of Hand-Splinting Practice: Perspectives and Experiences of Thai Occupational Therapists

“…Occupational therapists’ preferred splinting in hand function for children with neurological impairment. This finding agrees with those reported by Hepworth et al [ 30 ], who found that functional resting and neoprene thumb abduction splints are recommended in 80% of cases, anti-spasticity splints in 60% of cases, and both serpentine and supination splints in 32.5% of cases.…”

“…Prevention of bone and joint deformities was ranked first, prevention of muscular contracture was ranked second, and maintaining and increasing range of motion was ranked third when evaluating participants’ perspectives. However, Hepworth et al [ 30 ] evaluated patient factors when providing splinting therapy for children with neurological impairments and reported that maintaining and improving range of motion ranked first (97.5%), preventing contracture was ranked second (92.5%), and compliance with the caregiver ranked third (90%) per the respondents’ perspectives ( n = 40). In the study of network meta-analysis, hand therapy is important because it proves that Carpometacarpal (CMC) osteoarthritis (OA) patients are best treated with a long thermoplastic carpometacarpal-metacarpophalangeal splint (rigid CMC-MCP) for pain relief, while a short custom-made CMC-MCP splint can be used to improve hand function [ 31 ].…”

“…These factors were the primary considerations for splint selection and application among Thai occupational therapists ( Figure 2 ). Hepworth et al [ 30 ] found that hand splinting in children with a neurological impairment requires knowledge of the condition (92.5%), experience (82.5%), competency (80%), and available resources (75%). Similarly, Chazen and Franzsen [ 33 ] evaluated the opinion of experts regarding splinting adult patients with neurological conditions, who reported that occupational therapists should develop skills in fabricating splints and learn from others’ experiences with clinical practice.…”

The role of Occupational Therapy in Africa: A scoping review

“…Although many of the generic tasks and activities mentioned in the articles appear to be the same for occupational therapists in any country (e.g., assessment, education, environmental adaptation, skills training), the context influences therapists' priorities and approach. For example, several authors describe how, in assessment, occupational therapists often rely on informal methods (e.g., observation, interview) or adapt formal measures because most standardised tools are developed in Western countries 34,35 . In terms of interventions, the prevalence of poverty and limited employment opportunities for people with disabilities in various African contexts behoves occupational therapists to focus on vocational skills [36][37][38] , facilitating self-employment 39 and other options for income generation 30,31,40 .…”

“…Unfortunately, there can be discrepancy between evidence and practice, often due to the challenges associated with accessing appropriate research evidence 34,113 . Therefore, research skills are an important component in occupational therapy education in African contexts, and even in countries where research is incorporated as part of standard training (i.e., South Africa), further development is needed 103,114 .…”